Barnes, Keely2024-11-182024-11-182024-11-18http://hdl.handle.net/10393/49859https://doi.org/10.20381/ruor-30688Background: Workplace concussions can have a significant impact on workers. Many workers live far from concussion assessment centers, making it challenging to receive specialized assessment post-injury. The COVID-19 pandemic heightened challenges as in-person assessments for non-urgent cases was significantly reduced. However, the pandemic did create an opportunity for researchers and clinicians to explore the use of virtual assessment in practice. This shift exposed an area that requires further investigation as there is limited information regarding how virtual assessments should be done and which measures should be used. Further, there is limited information on the barriers and facilitators associated with the virtual approach to assessment. Finally, information regarding the specific feasibility of administering concussion measures virtually and the properties associated with administering these measures virtually is minimal. To understand these virtual properties in relation to the in-person assessment, there is also a gap in knowledge in that the synthesis of psychometric properties associated with certain measures administered in-person is not well articulated in the literature. Objectives: The aim of this dissertation was to: 1) develop a virtual physical concussion assessment toolkit for use by clinicians who are treating workers injured on the job and presenting with persistent symptoms; 2) investigate the feasibility of the developed assessment and associated study procedures and document preliminary information regarding the reliability and sensitivity of the virtual physical assessment when compared to a corresponding in-person assessment; and 3) document the psychometric properties associated with in-person administration of a subset of measures included in the virtual physical assessment toolkit for purposes of comparison of the properties when administered in the two different contexts (explored in a project that goes beyond this dissertation). Methodology: This dissertation consists of four projects. The first two projects together address aim 1 and follow a sequential mixed methods study design. This consisted of survey administration guided by the Delphi approach, working group completion with expert clinicians (Chapter 3), and focus group completion with clinicians and people living with workplace concussions (Chapter 4). A feasibility study design to answer aim 2 was then followed and consisted of patient-participants attending in-person and virtual assessments at the Ottawa Hospital (Chapter 5). The measures identified in Chapters 3 and 4 were used to complete these feasibility study assessments. Finally, a scoping review was then completed to address aim 3 to identify and document the psychometric properties associated with a subset of the measures included in the feasibility study virtual assessment (vestibular and ocular measures) (Chapter 6). Results: The clinician-prioritized measures to include in a virtual physical assessment toolkit are documented and include the finger-to-nose test, Vestibular/Ocular Motor Screening (VOMS), cervical spine range of motion, balance testing (single leg stance test, tandem stance test, feet together), evaluation of saccades, and evaluation of effort. The barriers and facilitators associated with administering each of these measures are highlighted and include, respectively, factors such as questionable accuracy of administering the measures in a remote context and having adequate supports in place when completing a virtual assessment. The feasibility of administering these clinician-identified and prioritized measures in a virtual environment was investigated, which confirmed the acceptability of the environmental set-up and moderate to high levels of confidence in findings on the assessment by both clinicians and people with brain injuries. Preliminary information on psychometric properties associated with the virtual assessment indicate poor (0.0) to excellent (1.0) sensitivity and poor (Kappa=0.38-0.49) to excellent (Kappa=1.0) levels of inter-rater and intra-rater reliability. The psychometric properties of administering a subset of these measures (VOMS, saccades, balance testing) in-person was documented, and appear to vary significantly in the literature. Conclusion: This dissertation contributes to the advancement of knowledge in the field of concussion rehabilitation. Specifically, this work led to an initial understanding of the feasibility of the virtual concussion assessment (using specific measures related to the physical domains of a concussion examination), along with a preliminary understanding of possible properties associated with the measures. This work has provided important information regarding what is needed to further drive the understanding of virtual concussion assessment, and the barriers and facilitators associated with such virtual assessments.enAttribution-NonCommercial-NoDerivatives 4.0 Internationalhttp://creativecommons.org/licenses/by-nc-nd/4.0/concussionvirtual careassessmentworkplace injuryThesis